Age-Specific Prevalence and Clinical Characteristics of Humeral Medial Epicondyle Apophysitis and Osteochondritis Dissecans: Ultrasonographic Assessment of 4249 Players

Abstract

Background:Traction apophysitis of medial epicondyle (MEC) lesions and osteochondritis dissecans (OCD) of the capitellum are common elbow injuries in adolescent baseball players. However, the age-specific prevalence of these pathologies and their influence on elbow pain remain unknown.Purpose:To investigate the age-specific prevalence of each MEC lesion and capitellar OCD and to identify the incidence of elbow pain in each condition.Study Design:Descriptive epidemiology study.Methods:Study participants consisted of 4249 baseball players aged 6 to 17 years. A questionnaire was used to assess history of elbow pain, and morphological changes of the elbow joint were assessed using ultrasonography.Results:Regarding MEC lesions, fragmented (FG) and irregular (IR) lesions both reached their greatest respective prevalence at 11 to 12 years of age. After 14 years of age, IR decreased sharply, whereas FG was maintained at approximately 10%. Hypertrophic (HT) lesions increased sharply, reaching over 50% at 16 years of age, while there was a decrease in IR and FG lesions in the same age group. The prevalence of capitellar OCD remained the same (approximately 2%) throughout all ages except for in players aged 7 to 8 years (>7%). Players with MEC lesions had significantly greater prevalence of a history of elbow pain compared with those without (68.0% vs 39.1%) and were at a significantly greater risk for FG lesions (odds ratio [OR], 4.04; 95% CI, 3.16-5.22) compared with IR (OR, 3.22; 95% CI, 2.44-4.27) and HT lesions (OR, 2.03; 95% CI, 1.75-2.36). Players with capitellar OCD also had a significantly greater risk of a history of elbow pain (OR, 2.34; 95% CI, 1.40-4.11).Conclusion:Controlling the amount of practice and its intensity according to the condition of each player in the preadolescent and adolescent periods may be important in accelerating bony healing and decreasing preventable elbow pain in adulthood.

Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review

“…Twenty‐eight articles focused on pain of the elbow and/or shoulder related to overhead sports, published between 1965 and 2017. The studies were conducted in the USA, Japan, Norway, Brazil, Taiwan, and the UK . Sixteen of the articles that reported pain as outcome were cross‐sectional studies, nine articles collected data prospectively, and two studies had a retrospective design …”

“…Incidence and prevalence of elbow pain have only been described in baseball players and were 12%‐58% and 17%‐45%, respectively. Seventeen to 63% of youth baseball players reported a history of pain in the elbow. Incidence of shoulder pain was highest among handball‐ (63%) and volleyball players (52%) .…”

“…Twelve studies reported odds ratios (OR) for univariate analysis of risk factors for pain of the elbow or shoulder related to baseball . One study reported risk factors for overuse injuries in baseball players, and one study reported risk factors for shoulder pain in volleyball .…”

“…In addition, many athletes consider pain not as overuse problem but as part of the game and compete while having pain or while using medication . The importance of identifying and protecting these athletes that have overuse‐related pain is underlined by several studies demonstrating imaging abnormalities in a significant amount of uninjured youth athletes …”

Editorial Commentary: “There's No Crying in Baseball,” But There Is Osteochondritis Dissecans of the Elbow

“…3 Matsuura et al 2 report the incidence of OCD of the capitellum at 1.8% with 23 cases of 1,275 baseball players aged 6 to 11 years over a 1-year period based on screening ultrasound and confirmation with plain radiographs, magnetic resonance imaging, and computed tomography scanning. Using ultrasound as a screening tool in large populations, Matsuura et al 4 found a prevalence of 2.1% of OCD within 1,040 baseball players aged 10 to 12 years; Otoshi et al 5 found a prevalence of 2.2% of OCD within 4,249 baseball players aged 6 to 17 years; and Kida et al 6 found a prevalence of 3.4% of OCD within 2,433 baseball players aged 12 to 18 years. Although not highlighted in this study, by identifying 12 cases of OCD in the initial ultrasound screen of 1,423 baseball players aged 6 to 11 years, the authors found a prevalence of 0.8%.…”